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Post Prostatectomy 6 years. PSA <.01 until now. Anyone else?

Posted by Tom @tom86, 6 days ago

I have been fortunate enough to experience PSA results of <.01 post prostatectomy. Now, at the 6 year mark, I have had a result of .02. I realize this is not a huge amount, however, wondering if anyone else has had this experience and what to expect going forward. I was very high risk at T3b, SVI, ECE, PSA 11, PNI, 4 +3. Wondering if I should expect a rapid increase now that it has reared it's ugly head? I have been very blessed so far. I would appreciate hearing from anyone else who has had similar experience. Thank you. Tom

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Tom | @tom86 | 4 days ago
In reply to @rlpostrp "To put it into absolute clarity: a 0.02 PSA is a 100% increase over a 0.01..." + (show)
Profile picture for rlpostrp @rlpostrp

To put it into absolute clarity: a 0.02 PSA is a 100% increase over a 0.01 PSA. It is more significant than you think. Your urologist will likely do one of two things: 1) Refer you immediately to a radiation oncologist to discuss potential and likely radiation therapy, or...2) Start monitoring your PSA every three months again. He may order "ultra-sensitive PSA" tests instead so he can really monitor very subtle increases.
I too am/was a pT3b with left seminal vesicle (only) invasion. My PSA was only 6.1 though and I was a Gleason 3 + 4 = 7 with <10% of cells being grade "4." Good luck to you.

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@rlpostrp
Could not agree more. BCR is not 'official' until it reaches .2, however at the lower level if it is doubling, it is doubling. I have a call in to Radiology Oncology and hopefully will hear from them this week. The earlier the treatment can begin, the better the chances of catching it before it takes off (hopefully).

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Tom | @tom86 | 4 days ago
In reply to @marlon "I am 2+ years post-surgery. My PSA has been < detect since then. My doctor said..." + (show)
Profile picture for marlon @marlon

I am 2+ years post-surgery. My PSA has been < detect since then. My doctor said that even if does come back, it will be so slow growing that there would be plenty of time to address it. I interpreted that as he expects i'll die of something else before it's a problem. But more importantly, the PSA level would have to be high enough to identify exactly where it was occurring so that they could target treatment appropriately. That is, no general blasting of the area with radiation without a target.

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@marlon
Just curious; are you being seen at one of the centers of excellence. if you don't mind sharing?
TYIA

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Jeff Marchi | @jeffmarc | 4 days ago
In reply to @rlpostrp "To put it into absolute clarity: a 0.02 PSA is a 100% increase over a 0.01..." + (show)
Profile picture for rlpostrp @rlpostrp

To put it into absolute clarity: a 0.02 PSA is a 100% increase over a 0.01 PSA. It is more significant than you think. Your urologist will likely do one of two things: 1) Refer you immediately to a radiation oncologist to discuss potential and likely radiation therapy, or...2) Start monitoring your PSA every three months again. He may order "ultra-sensitive PSA" tests instead so he can really monitor very subtle increases.
I too am/was a pT3b with left seminal vesicle (only) invasion. My PSA was only 6.1 though and I was a Gleason 3 + 4 = 7 with <10% of cells being grade "4." Good luck to you.

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@rlpostrp
The NIH disagrees with what you are saying. They specifically said that changes in PSA with that low a number are not relevant.

It’s not time to start action. It’s time to wait for the next Test.

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Tom | @tom86 | 4 days ago
In reply to @jeffmarc "@rlpostrp The NIH disagrees with what you are saying. They specifically said that changes in PSA..." + (show)
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@rlpostrp
The NIH disagrees with what you are saying. They specifically said that changes in PSA with that low a number are not relevant.

It’s not time to start action. It’s time to wait for the next Test.

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@jeffmarc
There is an article in Pub Med that states clearly if you reach a consistant level of uPSA <.03 post prostatectomy you have a 98% chance of proceeding to BCR. More physicians are looking at lower levels of uPSA to determine if earlier salvage radiation is the way to go. Further studies seem to indicate it is. I will know more after speaking with R/O this week at UC. In my case, still need to wait for the next test. Not to .03 yet.

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Jeff Marchi | @jeffmarc | 4 days ago
In reply to @tom86 "@jeffmarc There is an article in Pub Med that states clearly if you reach a consistant..." + (show)
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@jeffmarc
There is an article in Pub Med that states clearly if you reach a consistant level of uPSA <.03 post prostatectomy you have a 98% chance of proceeding to BCR. More physicians are looking at lower levels of uPSA to determine if earlier salvage radiation is the way to go. Further studies seem to indicate it is. I will know more after speaking with R/O this week at UC. In my case, still need to wait for the next test. Not to .03 yet.

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@tom86
Researching this seems to show that it does not lead to a 98% BCR rate. But it is something to look at after a prostatectomy, but it is not that aggressive, yet.

A consistent ultra-sensitive PSA (uPSA) level below 0.03 ng/mL after a prostatectomy is actually associated with a low risk of recurrence, not a 98% chance of biochemical recurrence (BCR). Literature indexed in PubMed indicates that staying at or below 0.03 ng/mL correlates with high recurrence-free survival rates, whereas crossing above the 0.03 ng/mL threshold is what researchers identify as an early warning sign or optimal sensitivity cutoff for tracking potential recurrence.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4527538/

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Tom | @tom86 | 4 days ago
In reply to @jeffmarc "@tom86 Researching this seems to show that it does not lead to a 98% BCR rate...." + (show)
Profile picture for Jeff Marchi @jeffmarc

@tom86
Researching this seems to show that it does not lead to a 98% BCR rate. But it is something to look at after a prostatectomy, but it is not that aggressive, yet.

A consistent ultra-sensitive PSA (uPSA) level below 0.03 ng/mL after a prostatectomy is actually associated with a low risk of recurrence, not a 98% chance of biochemical recurrence (BCR). Literature indexed in PubMed indicates that staying at or below 0.03 ng/mL correlates with high recurrence-free survival rates, whereas crossing above the 0.03 ng/mL threshold is what researchers identify as an early warning sign or optimal sensitivity cutoff for tracking potential recurrence.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4527538/

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@jeffmarc I will attempt to attach the link I am referring to. It is clear. Not aggressive yet, however will lead to BCR with a 98% certainty. 2% chance it will not. If you have been at <0.01 and you advance to .03 in (whatever) the period of time, that is a 300% increase in protein level. Common sense.

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Jeff Marchi | @jeffmarc | 4 days ago
In reply to @tom86 "@jeffmarc I will attempt to attach the link I am referring to. It is clear. Not..." + (show)
Profile picture for Tom @tom86

@jeffmarc I will attempt to attach the link I am referring to. It is clear. Not aggressive yet, however will lead to BCR with a 98% certainty. 2% chance it will not. If you have been at <0.01 and you advance to .03 in (whatever) the period of time, that is a 300% increase in protein level. Common sense.

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@tom86
If you looked at the link, I included, it said this

With biochemical recurrence diagnosed at uPSA ≥0.03, the majority (72%) of the high-risk cohort had failed by the median follow-up of 44 months.

72% does not equal 98% but it is not a good percentage to have to face.

Another factor, however, is that that these were high risk patients, Not your normal risk level patients. I wonder what your study really showed.

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diverjer | @diverjer | 4 days ago

Okay this may be a really stupid, but why would you ever get a DRE after prostate removal? What are they going to feel for, prostate is gone?

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brucemobile | @brucemobile | 3 days ago

I’m 1 year almost to the day post surgery. My PSA has been > .005. When I talked to my RO he told me that there was still some of the cancer left at the very edge of the seminal gland and if i ever had a reoccurrence he would know exactly where the area is that needed to be treated

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chippydoo | @chippydoo | 3 days ago
In reply to @melvinw "The urologist who performed my prostectomy did a DRE with every PSA test until he retired..." + (show)
Profile picture for melvinw @melvinw

The urologist who performed my prostectomy did a DRE with every PSA test until he retired 9 years later. There appears to be a move away from DREs, I guess because many guys don’t like them and they are “too subjective.” They never really bothered me, especially compared to a transrectal needle biopsy. Anyway, I hope my story provides you with sufficient reason to counter the “no PSA, no need for a DRE”. Maybe statistically that has some merit, but I’m living proof that it is not invariably true. Yup, self advocate firmly.

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DRE is routine at the urological practice I go to. The "let's get this over with" lead in. I hope they don't go back to the comfort exam, as PSA is so inconclusive.

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